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Aggressive Intervention (aggressive + intervention)
Selected AbstractsDown syndrome: Common otolaryngologic manifestations,AMERICAN JOURNAL OF MEDICAL GENETICS, Issue 3 2006Sally R. Shott Abstract Otolaryngologic or ear, nose, and throat (ENT) problems are common in children with Down Syndrome (DS). This includes problems with chronic ear infections and chronic middle ear effusions with associated hearing loss, airway obstruction, and sleep apnea, as well as problems with chronic rhinitis and sinusitis. In addition, many of these ENT problems require surgical interventions, and there are special anesthesia considerations that need to be addressed in children with DS. These include subglottic stenosis, post-operative airway obstruction, and cervical spine concerns. As the care of children with DS has become more consistent and proactive, outcomes from the treatment of these ENT manifestations have improved. Aggressive interventions, both medical and surgical, have led to a decreased incidence of hearing loss, good control of the chronic rhinitis, and a better awareness of the incidence of sleep apnea and sleep-disordered breathing in individuals with DS. These common otolaryngologic manifestations of DS are reviewed with recommendations for ongoing care and monitoring. © 2006 Wiley-Liss, Inc. [source] Natural History of Asymptomatic Intracranial Arterial StenosisJOURNAL OF NEUROIMAGING, Issue S1 2009Robert A. Taylor MD ABSTRACT The prevalence and natural history of asymptomatic intracranial arterial stenosis are not very well characterized. Existing data suggest that incidentally discovered asymptomatic intracranial stenosis presents a fairly low risk of stroke, though substantial uncertainty remains. Patients may be at greater risk if there are tandem stenoses. Methods to stratify the risk of stroke with asymptomatic intracranial atherosclerotic lesions have yet to be established and validated. In general, aggressive intervention for an asymptomatic intracranial stenosis is not currently recommended. [source] Evaluation of Insulin Sensitivity in Clinical Practice and in Research SettingsNUTRITION REVIEWS, Issue 12 2003Lais U. Monzillo MD Insulin resistance is the core metabolic abnormality in type 2 diabetes. Its high prevalence and its association with dyslipidemia, hypertension, hyperinsulinemia, and high coronary and cerebrovascular mortality put it in the forefront as the plausible target for aggressive intervention. Measurements of insulin sensitivity provide clinicians and clinical researchers with invaluable instruments to objectively evaluate the efficiency of both current and potentially useful interventional tools. Although several methods had been developed and validated to evaluate insulin sensitivity, none of these methods can be universally used in all patients. Nonetheless, a method suitable for use in clinical or basic research may not necessarily be a practical method for use in clinical practice or for epidemiologic research. We reviewed the currently used methods for assessment of insulin sensitivity. For each method, we summarized its procedure, normal value, cut-off value for defining insulin resistance, advantages and limitations, validity, accuracy for each patient population, and suitability for use in clinical practice and in research settings. The methods reviewed include fasting plasma insulin, homeostatic model assessment, quantitative insulin sensitivity check index, glucose-to-insulin ratio, continuous infusion of glucose with model assessment, indices based on oral glucose tolerance test, insulin tolerance test, and the so called "gold standard" methods, the hyperinsulinemic euglycemic clamp and the frequently sampled-intravenous glucose tolerance test. [source] 2.,The Democratic Peace Myth: From Hiroshima to BaghdadAMERICAN JOURNAL OF ECONOMICS AND SOCIOLOGY, Issue 1 2009Andrew Fiala This paper examines the ideal of the democratic peace and the recent misuse of this ideal in the war on terrorism. It argues against the idea that aggressive military force can be employed to bring about the ideal of the democratic peace. By looking at John Stuart Mill's utilitarian justification of benevolent despotism for "barbarians," it examines how idealism can lead to a defense of aggressive intervention. And it considers how idealistic zeal can lead to violations of just war principles, as in the case of Hiroshima. It concludes by arguing that Kant's deontological approach is better. Kant provides us with a reason to hope that as democracy spreads, peace will spread as well. But Kant also prohibits us from using force to actualize this ideal. [source] Microchip, reverse transcription-polymerase chain reaction and culture methods to detect enterovirus infection in pediatric patientsPEDIATRICS INTERNATIONAL, Issue 1 2006LON-YEN TSAO Abstract Background: Enterovirus infection usually presents with mild and self-limited illness in children. However, Enterovirus type 71 can be characterized by neurotropism and may cause severe illness or even sudden death. Early detection of the virus will allow a physician to provide intensive or aggressive intervention. The purpose of the present study was to compare sensitivity of two innovative laboratory methods, that is, the DR.EV microchip method (DR. Chip Biotechnology, Shin-Tsu, Taiwan) and the reverse transcription-polymerase chain reaction (RT-PCR) method following conventional virus culture in detecting enterovirus infection in pediatric patients with herpangina or hand,foot,mouth disease. Methods: A total of 87 children (age range: 1,8 years) were enrolled because of typical clinical findings of herpangina and hand,foot,mouth disease. Two hundred children selected after a careful clinical history review and physical examinations, were included as controls. All of these children had at least throat swab and rectal swab specimens taken and tested for evidence of enterovirus infection by microchip, RT-PCR and virus culture methods. In addition, 21 patients also had cerebrospinal fluid (CSF) specimens taken to test for possible central nervous system involvement. Result: The test results obtained from the 200 healthy kindergarten children were all negative for enteroviral infection by these three methods. Among the 87 test patients, the positive rates for throat swab, rectal swab and CSF by DR.EV chip, RT-PCR and virus culture were 71%, 68%, and 45% (throat swab); 66%, 61%, and 33% (rectal swab); and 52%, 29%, and 5% (CSF), respectively. There was no significant difference in the positive rates between the DR.EV chip and the RT-PCR methods (P > 0.1) on all types of specimens. However, statistically significant differences in positive rates were noted between the DR.EV chip and the conventional virus culture methods on all types of specimens (P < 0.001). Sensitivity of the microchip, RT-PCR and virus culture methods, was 82%, 72%, and 53%, respectively. Conclusion: The DR.EV chip method yielded a statistically higher positive rate and faster test results than the conventional viral culture method. [source] Selective Retransplant After Graft Loss to Nonadherence: Success with a Second ChanceAMERICAN JOURNAL OF TRANSPLANTATION, Issue 6 2009T. B. Dunn Nonadherence (NA) is a difficult posttransplant problem that can lead to graft loss. A retransplant is controversial because of a fear of recurrent NA. We reviewed our center's data base and identified 114 kidney recipients who lost their graft to overt NA; of this group, 35 (31%) underwent a retransplant after a thorough reevaluation. We compared this NA retransplant group to a control group of second transplant recipients who did not lose their first graft to overt NA (non-NA) (n = 552). After 8 years of follow-up, we found no significant differences between the groups in actuarial graft or patient survival rates, renal function, or the incidence of biopsy-proven chronic rejection. However, 5 of 35 (14%) NA recipients versus 10 of 552 (2%) non-NA recipients lost their retransplant to NA (p = 0.0001). Twenty of 35 (57%) of the NA group exhibited repeat NA behavior after retransplant. We conclude that prior graft loss to NA is associated with increased graft loss to NA after retransplant. However, the majority of NA retransplant recipients did well,with overall long-term outcomes similar to those of the non-NA group. With careful patient selection and aggressive intervention, prior overt NA should not be an absolute contraindication to retransplantation. [source] Reversibility of acute intermediate phase bilirubin encephalopathyACTA PAEDIATRICA, Issue 10 2009Thor Willy Ruud Hansen Abstract Aim:, To show the potential for reversing acute intermediate to advanced phase bilirubin encephalopathy. Methods:, Case studies. Results:, Six extremely jaundiced infants had symptoms of intermediate to advanced phase acute bilirubin encephalopathy. The infants were treated aggressively. Two patients had brain magnetic resonance imaging showing increased signals in the globus pallidus. On follow-up, all infants are neurologically normal. Conclusions:, Intermediate-to-advanced stage acute bilirubin encephalopathy may occasionally be reversible. These cases provide a strong argument in favour of rapid and aggressive intervention in infants presenting with extreme jaundice and neurological symptoms. [source] How do we achieve optimal cardiovascular risk reduction?CLINICAL CARDIOLOGY, Issue S3 2001Antonio M. Gotto Jr. M.D., D.PHIL Abstract Summary: Optimizing coronary heart disease (CHD) risk reduction requires the application of clinical evidence to patient care, as well as the refinement of risk assessment. Clinical evidence indicates that most patients are not treated to optimal low-density lipoprotein (LDL) cholesterol goals. Despite the efficacy of statin therapy in reducing the incidence of CHD, many treated patients still experience CHD events. Targeting other lipid factors such as high-density lipoprotein cholesterol and triglycerides may augment the risk reduction achieved by lowering LDL cholesterol. Refined global risk assessment can lead to more accurate determinations of absolute risk and to the identification both of high-risk patients needing aggressive intervention and intermediate-risk patients who appear to be at low risk. Previous global risk assessment measures failed to identify a substantial proportion of primary prevention patients who would benefit from therapy. However, revised guidelines issued by the National Cholesterol Education Program introduce new criteria for more precise risk assessment and advocate use of the Framingham scoring system to calculate absolute risk. Although intensified treatment is recommended for high-risk patients, cost considerations may limit drug therapy for some lower-risk individuals. [source] Positioning biologic agents in the treatment of Crohn's disease,INFLAMMATORY BOWEL DISEASES, Issue 10 2009Stephen B. Hanauer MD Abstract One decade after the emergence of biologic therapy for Crohn's disease (CD), our treatment algorithms are beginning to change. Once reserved for patients with refractory disease, disease unresponsive to conventional therapies, or those requiring multiple courses of corticosteroids, there is increasing evidence that early, aggressive interventions with immunosuppressants or biologic therapies targeting tumor necrosis factor-, or ,-4 integrins can alter the natural history of CD by reducing the transmural complications of structuring and fistulization and the nearly inevitable requisite for surgical resections. More recent trials are beginning to suggest that intervention with combination therapy for selected patients with a poor prognosis may modify the long-term course of CD. Selection of patients with features predicting a complex or progressive course and early, combined intervention is now possible. Future studies are still needed to best identify predictors of response to individual agents with differing mechanisms of action, as well as to optimize the risk-benefit of long-term maintenance therapy. (Inflamm Bowel Dis 2009) [source] Successful treatment of malignant melanoma in situ with topical 5% imiquimod creamINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 5 2005Carolyn M. Ray MD Background, Current treatment recommendations for malignant melanoma in situ include surgical excision with at least 0.5 cm margins. On the head or neck, obtaining adequate surgical margins for melanoma can be challenging and often disfiguring. In addition, some elderly patients may not be good surgical candidates and may request less aggressive interventions. Methods, We report herein three cases of malignant melanoma in situ on the face treated with topical imiquimod cream. Results, Complete regression of malignant melanoma in situ was observed on treatment with 5% topical imiquimod cream. The varied treatment regimens, rationale for using imiquimod rather than performing surgery, and the possible mechanisms of action are discussed. Conclusions, Topical imiquimod can be used successfully for the treatment of malignant melanoma in situ on the face. [source] Re: Prediction of the fetal Kell blood group reduces aggressive interventionsAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 5 2005F. ARAÚJO No abstract is available for this article. [source] | ||||||||||